Department of Specialist Surgical Sciences, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy.
Otolaryngol Head Neck Surg. 2011 May;144(5):784-8. doi: 10.1177/0194599810394955.
Biofilms are organized bacterial communities that are playing an increasing role in otolaryngological diseases such as chronic or recurrent middle ear otitis and adenotonsillitis. Various cultural techniques are available to detect biofilm-producing bacteria (BPB), but microbiological analysis of bioptic staining is the reference diagnostic procedure. To our knowledge, the accuracy of nasopharyngeal swabs in diagnosing BPB has never been assessed.
A prospective study of diagnostic accuracy.
Outpatient clinics of the Departments of Specialist Surgical Sciences and Maternal and Pediatric Sciences, University of Milan, Italy.
Forty-two pediatric subjects with chronic adenoiditis (aged 4-18 years) underwent adenoidectomy, during which multiple transoral nasopharyngeal swabs and adenoidal biopsies were performed. BPB were detected by spectrophotometry, and the accuracy of detecting BPB in nasopharyngeal swabs was compared with that of biopsy.
BPB were detected in 73.8% of the nasopharyngeal swabs and in 69.1% of the biopsies. The sensitivity and specificity of the nasopharyngeal swabs were, respectively, 75.9% (95% confidence interval [CI], 60.3%-91.4%) and 30.8% (95% CI, 5.7%-55.9%); positive and negative predictive values were, respectively, 71.0% (95% CI, 55.0%-86.9%) and 36.4% (95% CI, 7.9%-64.8%); and the area under the receiver-operating characteristic curve was 0.5 (95% CI, 0.4-0.7).
In comparison with biopsy, nasopharyngeal swabs seem to be inaccurate in detecting BPB and should be cautiously used in clinical practice. As these preliminary findings may have been due to the well-known resistance of biofilm to mechanical injuries (such as swab rubbing) or the small study population, they need to be confirmed in larger patient series.
生物膜是一种组织化的细菌群落，在耳鼻喉科疾病（如慢性或复发性中耳中耳炎和腺样体扁桃体炎）中发挥着越来越重要的作用。有多种文化技术可用于检测产生物膜细菌（BPB），但生物染色的微生物分析是参考诊断程序。据我们所知，鼻咽拭子诊断 BPB 的准确性从未被评估过。
一项诊断准确性的前瞻性研究。
意大利米兰大学专科外科科学和母婴科学系的门诊。
42 名患有慢性腺样体炎的儿科患者（年龄 4-18 岁）接受了腺样体切除术，在此期间进行了多次经口鼻咽拭子和腺样体活检。通过分光光度法检测 BPB，并比较鼻咽拭子与活检检测 BPB 的准确性。
在 73.8%的鼻咽拭子和 69.1%的活检中检测到 BPB。鼻咽拭子的敏感性和特异性分别为 75.9%（95%置信区间[CI]，60.3%-91.4%）和 30.8%（95% CI，5.7%-55.9%）；阳性和阴性预测值分别为 71.0%（95% CI，55.0%-86.9%）和 36.4%（95% CI，7.9%-64.8%）；受试者工作特征曲线下面积为 0.5（95% CI，0.4-0.7）。
与活检相比，鼻咽拭子似乎在检测 BPB 方面不准确，在临床实践中应谨慎使用。由于这些初步发现可能是由于生物膜对机械损伤（如拭子摩擦）的明显抵抗力或研究人群较小所致，因此需要在更大的患者系列中进行确认。
